Curbing the Violence

Violence in the workplace continues to escalate; healthcare workers at risk

By Paul Baratta

Aug 01, 2017

Let me let you in on a troubling, not-so-little secret: violence
in the workplace is continuing to escalate in medical
facilities, despite the fact that national assault rates
have been dropping in recent years. In a statement by
the International Council of Nurses, they noted that
healthcare workers are more likely to be attacked at work than prison
guards or police officers.

Why are people in these environments so vulnerable? And what
can hospitals, emergency care units and mental health facilities do to
better protect staff, patients and visitors?

What’s Triggering the Rise in Violence?

Formulating a strategy for addressing this problem begins with examining
its root causes. Healthcare settings tend to be stressful environments
for an array of reasons. Stress can trigger disruptive, and
sometimes even violent, behavior. Just look at today’s headlines for examples
of how stress has been affecting behavior on crowded airplanes.

What are some of the most common stressors in medical facilities?

Increased wait times in hospital emergency centers.

Behavioral patients admitted to emergency departments with little
or no information, and no intake facility willing or able to take
the patient.

Increased use of hospitals for treatment of acutely disturbed individuals
in lieu of jail or holding at police departments.

Vulnerabilities stem from the open design of many medical facilities
such as the unrestricted movement of visitors, spillover of gang
activity from the streets or prevalence of firearms entering the building.
Other issues stem from financial constraints and lack of staff
training because of budgets cuts forcing leaner security staff, inconsistent
adherence to security protocols and staff inability to recognize
warning signs of potentially violent behavior.

People. From a people perspective, it starts with senior leadership
accepting the fact that there’s always potential for violence in
the workplace. So management must be willing to commit adequate
funds to curb it. This includes actively promoting a workplace culture
that values the importance of security.

Employee education is paramount. Everyone should be informed
of the purpose of security measures and prevented from circumventing
electronic security devices put in place for their protection.

Security staff should be empowered to enforce rules and regulations
regarding workplace violence. They should also be responsible
for maintaining close relationships with local law enforcement, relying
on them for a rapid response if the situation warrants it. They
should record any incidents of workplace violence and report them
to the facility’s appropriate departments. Those reports should be
tracked to determine if there are noticeable trends and what is being
done to address them.

Human Resources should take all incidences of workplace violence
seriously and deal with problems immediately—including removing
staff if that is the issue. HR should also oversee after care
follow-up for any individuals involved in an incident.

Procedure. It’s important for healthcare institutions to create policies,
procedures and guidelines around workplace violence. Human
Resources, risk management, security, senior leadership as well as
frontline staff should all provide input to ensure that these programs
address the actual safety and security risks of the facility. All policies
should also include after-care follow-up for victims.
While it would be impossible to create an exhaustive list of categories
for workplace violence that a facility’s policies, procedures and
guidelines should address, here are just a few examples.

Domestic violence. Include incidents that occur at staff or patients’
homes as well as at the healthcare facility. The policy should
include notifying security and local police (if appropriate), Human
Resources and risk management, and requesting a response. It’s important
that all parties are notified and that information is shared
rather than held by a single department.

In regards to incidents that might involve staff on staff, set ground
rules to ensure everyone’s safety. Make it clear that violation of those
rules by any staff member will lead to immediate termination.

Workplace violence. Encompass incidents occurring anywhere
on hospital grounds whether perpetrated on staff, patients, visitors,
or even service providers. Policies should outline the appropriate response
to take and any consequences that will be levied for an incident
whether it involves staff visitors, patients, or any member of the
healthcare community.

Policies for workplace violence must also include after care follow
up for any victims.

Rape and sexual assault. This pertains to events occurring at the
facility. The policies and guidelines set for any rape or sexual assault
should include immediately reporting the incident to local law enforcement
and the medical facility’s police department. There should
also be detailed guidelines established for collecting forensic evidence
to support an investigation of the incident.

Active shooter. In addition to having policies and procedures in
place for response to an active shooter, healthcare facilities should
also institute mandatory annual training of security and staff in active
shooter scenarios. The training should encompass prevention,
mitigation, preparation, and response and recovery.
Train security and staff to recognize potential signs of a pending
threat and conduct threat assessments. Is an individual more belligerent
than usual, showing up late for work, insubordinate to supervisors,
showing signs of depression or rage? Do they have easy access to
a weapon or something that could serve as a weapon?
Technology. There is an array of technologies available on the market
today to assist healthcare facilities in improving safety and security.
What a facility deems most important to deploy will depend on risk
assessment and budgetary considerations. Here are a few options:
Video surveillance. Install IP video cameras in strategic areas to
monitor patients, staff and visitors. They can also be deployed in
high-risk behavior rooms to enable security to watch more than one
patient simultaneously. Add analytics like sound detection to enhance
risk mitigation.

Access control. Use keycards, touchpads and/or biometrics to
limit access to specific areas. Create a layered approach to granting
entry privileges—becoming progressively more restrictive moving
from property perimeter to building perimeter to interior perimeters
to highly-sensitive innermost areas where security risks are highest.

Body cameras. These can be issued to security officers, EMTs and
emergency department staff.

Staff duress alarms. These can be installed at intake desks and
nurses stations or carried on-person (real-time location systems).
With preprogrammed cellphones staff can quickly inform security of
a volatile situation.

Mass notification systems. These are especially useful for broadcasting
messages facility-wide in case of an active shooters or need
for immediate emergency evacuation.

Curbing Violence Isn’t a
One-and-Done Process

Curbing violence in a healthcare workplace begins with a comprehensive
review of the security measures currently in place. This would
include any video surveillance and access control technology currently
deployed. The next step is to evaluate and review any workplace
violence policies to determine whether they are still timely or need to
be updated. Security measures, policies and incident reports should
be reviewed at least annually.

All staff—police, security emergency department personnel, social
workers, psych services, physicians and incoming residence—should
be cross-trained on how to respond to workplace violence and active
shooter and be required to attend an annual refresher course. They
should also attend non-violence crisis intervention training to help
them recognize early warning signs of potential violence.

Matching Institutional Vigilance
with Personal Vigilance

While risk management is assessing the work environment, for their
own safety and security employees should be looking at the workplace
with an equally critical eye. Is the lighting adequate? Are there
convenient escape routes? Do I have a method to summon assistance?
Staff needs to be proactive and pay attention to warning signs. As a
matter of course, they also need to report threats from patients, coworkers
and others immediately.

Other things an individual can do to help curb workplace violence
include:

Promote respect. Fostering an attitude of respect and consideration
can often defuse explosive behavior.

Eliminate potential weapons. Take an inventory of objects that
might serve as potential weapons. Remove or secure objects that
could be dangerous.

Know violence response procedures. Learn techniques to help you
respond during violent incidents in a way that minimizes injuries.
Also have a plan for summoning assistance and moving people
out of danger and into safe areas.

Trust your instincts. Don’t ignore your own internal warning system.

Work as a team. If you find yourself in a potentially hostile situation,
use the buddy system to extricate yourself.

All employees have a right to a violence-free workplace. By following
these tips, effectively enforcing workplace violence
prevention policies, and training staff how to
recognize and react to violent situations, healthcare
facilities can minimize risks to their patients, staff
and visitors and curb violence in their workplace.

This article originally appeared in the August 2017 issue of Security Today.